CERTIFICATION REQUEST FORM

v.10.2023

INSTRUCTIONS:
1. Print, fill-out & affix wet ink signature. No digital signatures.
2. Update your COL account via https://my.colfinancial.com before submission of this form to COL’s Operations Department.
3. Submit through email at stockcerts@colfinancial.com

CERTIFICATION REQUEST TYPE (Put a check mark on your chosen request and fill out the details needed)
☐ Certification for Visa Application Country and name of embassy:
Fee: P100.00
Complete address of the embassy to be indicated in the certification:

☐ Certification for General Purpose Specify reason:

Fee: P100.00
☐ Certification of Monthly Account Ledgers Specify starting period MM/YYYY Specify ending period MM/YYYY
Fee: P100.00 per monthly ledger
☐ Certification for Estate Proceedings Date of Death
Fee: none

NAME OF REQUESTOR (Choose one)

☐ Primary Account Holder ☐ Secondary Account Holder ☐ Both Account Holders
Note: If the chosen requestor is BOTH, two (2) certifications will be made. One for each account holder. The processing fee will be P200.00

DELIVERY METHOD (Choose one and fill out the detailed needed below)
☐ Self pick-up at COL Business Center
☐ Pick-up by Authorized Representative at COL Business Center
Client(s) hereby authorize their representative whose printed name and specimen signature appears below, to pick-up the certificate(s) on their behalf.
Authorized Representative’s Name Authorized Representative’s Specimen Signature

☐ Scan and email to registered email address

☐ Mail Courier to be sent to the address below.
Mail courier charge: P200.00 for local deliveries. International delivery charges would vary
No. & Street Building/Subdivision Town/District

City/Province Postal/Zip Code Country

Note: COL Business Center is located at 24th Flr, East Tower, Tektite Towers, Exchange Road, Ortigas Center, Pasig City, PH

Terms & Conditions: The total fees will be debited from your COL Account for every requested certification. COL shall not be responsible for any delay that may be
caused by the courier. COL reserves the right to hold delivery of certifications until accounts are aptly funded for payment. Original certifications not picked up or
couriered to the account holder will be disposed of after 3 months.

PRIMARY ACCOUNT HOLDER’S SIGNATURE OVER PRINTED NAME SECONDARY ACCOUNT HOLDER’S SIGNATURE OVER PRINTED NAME
COL ACCOUNT # EMAIL ADDRESS:

CONTACT # DATE SIGNED:

FOR CERTIFICATION FOR ESTATE PROCEEDINGS

HEIR’S SIGNATURE OVER PRINTED NAME RELATIONSHIP OF HEIR TO COL ACCOUNT HOLDER
COL Financial is a PSE Trading participant, SCCP & SIPF Member
COL is regulated by the Securities and Exchange Commission with email address msrdsubmission@sec.gov.ph